If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, you could consider talking to your doctor about taking CBD with a very low-dose THC product. Be aware that even at low levels, THC may make you feel high, resulting in cognitive, motor, and balance impairment.
There are some warnings and adverse drug interactions to be aware of before beginning using CBD for management of RA-associated pain.
Research in this area is ongoing.
Preparation and Dosage
Your dosage depends on a number of factors:
If you have RA, you should not stop taking your prescribed medications that may be protecting your joints from future damage. You should discuss any changes you want to make to your medication regimen with your doctor.
As cannabidiol (CBD) has grown in popularity over the years, major organizations like the Arthritis Foundation have released guidelines pertaining to its use in the treatment of rheumatoid arthritis (RA). CBD is a non-psychoactive component of cannabis. The CBD in most products is extracted from hemp, a variety of cannabis that only has traces (up to 0.3%) of THC, the active compound that gets people high. Studies have shown CBD can help reduce chronic pain by impacting endocannabinoid receptor activity, which may also reduce inflammation.
CBD may also raise levels of other medications in your blood by the same mechanism that grapefruit juice does.
There is one definite downside: cost. Prices range widely but CBD products aren’t inexpensive, and depending on dose, frequency, and formulation, the cost can be considerable — I found one brand that was $120/month, and health insurance does not usually cover it.
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There’s a good chance you’ve tried it already: according to a Gallup poll in August of 2019, about 14% of Americans report using CBD products, and the number one reason is pain. The Arthritis Foundation conducted its own poll and found that 29% reported current use of CBD (mostly in liquid or topical form), and nearly 80% of respondents were either using it, had used it in the past, or were considering it. Of those using it, most reported improvement in physical function, sleep, and well-being; of note, a minority reported improvement in pain or stiffness.
Are there guidelines about the use of CBD for chronic arthritis pain?
While there are laboratory studies suggesting CBD might be a promising approach, and animal studies showing anti-inflammatory and pain-relieving effects, well-designed studies demonstrating compelling evidence that CBD is safe and effective for chronic arthritis pain in humans do not exist. A randomized trial of topical CBD for osteoarthritis of the knee has been published, but in abstract form only (meaning it’s a preliminary report that summarizes the trial and has not been thoroughly vetted yet); the trial lasted only 12 weeks, and results were mixed at best. One of the largest reviews examined the health effects of cannabis and CBD, and concluded that there is “substantial evidence that cannabis is an effective treatment for chronic pain in adults.” But there was no specific conclusion regarding CBD, presumably because definitive studies were not available.
What’s the evidence it works? And what do experts recommend? Until recently, there’s been little research and even less guidance for people (or their doctors) interested in CBD products that are now increasingly legal and widely promoted.
Perhaps you’ve been tempted to try it. After all, most types of arthritis are not cured by other treatments, and CBD is considered a less addictive option than opiates. Or maybe it’s the marketing that recommends CBD products for everything from arthritis to anxiety to seizures. The ads are pretty hard to miss. (Now here’s a coincidence: as I was writing this, my email preview pane displayed a message that seemed to jump off the screen: CBD Has Helped Millions!! Try It Free Today!)
Dialogues in Clinical Neuroscience: “Cannabis, Cannabinoids, and Health.”
Cannabis and Cannabinoid Research: “Cannabis and Pain: A Clinical Review.”
CBD side effects are usually mild or moderate. They can include:
Mayo Clinic: “Mayo Clinic Q and A: Treatment with medical cannabis,” “Marijuana,” “What are the benefits of CBD — and is it safe to use?” “Rheumatoid arthritis.”
U.S. Drug Enforcement Administration: “Drug Scheduling.”
Nature Reviews Rheumatology: “Cannabinoids for the treatment of rheumatic diseases — where do we stand?”
If you use marijuana regularly, it could make you more likely to get anxiety, depression, and other mental illnesses.